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Infants Milk Depots.
I was requested by the Public Health Committee to make a report on the advisibility of having a
milk depot, and for "this purpose I visited in London the Lambeth and Battersea Municipal Depots
and in Leicester the Municipal Dried Milk Depot. The following reports were given to the Committee.
The matter was referred to the new Council and adjourned sini die.
" When the question of the prevention of infantile mortality first became prominent some ten or
twelve years ago, one of the remedies which received a great deal of attention was the provision of
sterilized or pasteurized cow's milk through the medium of infant milk depots. Discretion, however,
was not always used in choosing recipients for the milk, and a tendency to indiscriminate distribution
took place, the result being that the depots fell into disrepute with municipal bodies on account of
their expense, with the milk trade on account of the competition, and with the medical profession
because it was felt that they were encouraging the discontinuance of breast-feeding, to the detriment
of the infantile population.
Similar, however, is the history of almost every new remedy which has found a permanent place
in our pharmacopoeia. When first discovered enthusiasts make extravagant claims, then they fall
into disrepute, are rejected by everyone, and when they have lain dormant for a while someone
discovers that there is some good to be obtained from the remedies, and they finally find suitable
places in our armamentarium. The same may be said of milk depots, which, now that the early
extravagant claims have been given up, have now come to their proper position, and the next consideration
is : What is that position ?
There is no question whatever that the best food for infants is their mother's milk, and any
advice or system which tends to depreciate the value of it in the mother's eyes cannot be too strongly
deprecated, but we live in an artificial age, and even if every mother desired to adopt and continue
breast feeding, there will always remain a certain percentage who cannot commence, or, having
started, cannot continue breast feeding. The causes of this are various, and are attributable sometimes
to the mother and sometimes to the infant. The mother may be poor and badly nourished,
in which case the breast milk wall suffer ; she may be delicate or actually ill, or, if healthy, may lose
her milk from some unknown cause. On the other hand, she may start breast feeding, but for economic
reasons find it necessary to go to work at the end of the first three or four weeks of her infant's
life. Sometimes her infant is too weak to suck or has some congenital defect of the mouth, or the
milk may disagree with the infant, or the child may be too ill. All the possible causes are not stated
here, but the commonest have been mentioned. Now, if the baby for any reason cannot be breastfed,
the question comes to be what form of artificial food is the best, and this generally resolves itself
into what form of milk is best.
Among the upper classes there is as a general rule little difficulty, for with the help of their medical
adviser a cow's milk suitably modified can easily be obtained, but it costs money and it will be found
that all forms of commercial modified milk are much dearer than ordinary commercial milk. With
the working classes in Bermondsey, however, the matter is quite different. A cow's milk, really
reliable, and safe for infants, cannot be obtained here at prices within the reach of the poorest class,
the result being that they fly to the cheapest forms of skimmed milk, either fresh or tinned, which
means starvation for their infants. Such milk is often supplemented with all sorts of bits and scraps
from the parents' food, or else some form of biscuit. It is against this sort of thing that the Health
Visitors have been fighting for the last two years, but only too often, on telling the mother the injury
she is doing to her infant by giving skimmed milk, we get the reply that she cannot afford anything else.
We are constantly meeting cases of this sort in our mothers' class, and have many a time been at our
wits' end to get food for the infants. In a few of the extreme cases the guardians have supplied
milk for a short time, but this is not modified in any way to suit the infant, and when given out
at their offices there is not always a guarantee that the whole of it is used for the infant. A class of
case we meet with often is where the child is in delicate health, though not ill enough to be attended
by a doctor, and all it requires is a better milk suitably modified to meet its case; but we can do
nothing except recommend the mother, if she can afford it, to get some milk and dilute it with water
or barley-water.
Guy's" Hospital has recently started a special out-patient department for infants, and not infrequently
we get requests from the physician to try and get milk for some special case where this is the
only admissible diet and the parents seem too poor to supply it. The general practitioners in the
Borough would also welcome a depot where they could send infants under their care who require a good
modified milk. I often receive inquiries for them where such a thing can be got.
I think I have given enough detail to show that there is plenty of work for a depot in Bermondsey,
and if certain conditions were laid down under which milk will be supplied, I think there is little
danger of the depot being abused.
Such conditions would be (1) that the mother cannot breast feed, (2) that she must bring the infant
to the depot at stated intervals for weighing and examination, and submit to a certain amount of
supervision at the home. A good plan is to sell milk only to those who come with a recommendation
from a medical man.
To ascertain the present position of milk depôts in London, I visited the municipal depots of Battersea
and Lambeth. In both of these good milk is got from farms which are under strict sanitary
supervision. It is then modified to resemble the composition of human milk, boiled, sterilized or
pasteurized, and sold to poor mothers at a cheap rate for the purpose of feeding their infants ; or
if the mothers are nursing, then they can have good milk for themselves. The usual price for infants
under six months old is Is. 6d. per week, and for those over that age 2s. and 2s. 6d. per week. In
neither case does the sale of the milk cover the cost of the depot, the deficit being, in round numbers,
£500 and £300 per annum respectively. In Battersea the average number of infants at present
receiving is 150 and in Lambeth about 90. The cost of apparatus, etc., for starting the depot
in Battersea was £167 14s. lid. and in Lambeth about £200. In each place an ordinary dwellinghouse
was taken, and altered to suit the purpose of a milk depot. Besides accommodation for waitingroom,
apparatus, &c., two or three rooms are occupied as a dwelling-house by the manageress.
In dispensing milk for infants one feed of modified milk is placed in each bottle, so that the mother
has nothing to do but to place the bottle in a bowl of warm water, remove the stopper and replace